Adrenal Insufficiency
A 58-year-old woman comes to the office after she experienced a near-fainting spell 1 day ago. She was outside playing tennis when she vomited and felt
light-headed. She spent the rest of the day lying down with mild, diffuse, abdominal pain and nausea. She had no fever or diarrhea. She reports several
months of worsening fatigue, mild, intermittent, generalized abdominal pain, and loss of appetite with a 10- to 15-lb unintentional weight loss. Her medical
history is significant for hypothyroidism for which she takes levothyroxine. She takes no other medications. On examination, her temperature is 99.8°F, heart
rate is 102 bpm, blood pressure is 89/62 mm Hg, and normal respiratory rate. She does become light-headed, and her heart rate rises to 125 bpm upon
standing with a drop in systolic blood pressure to 70 mm Hg. She is alert and well tanned, with hyperpigmented creases in her hands. Her chest is clear, and
her heart rhythm is tachycardic but regular. On abdominal examination, she has normal bowel sounds and mild diffuse tenderness without guarding. Her
pulses are rapid and thready. She has no peripheral edema. Initial laboratory studies are significant for Na 121 mEq/L, K 5.8 mEq/L, HCO3 16 mEq/L, glucose
52 mg/dL, and creatinine 1.0 mg/dL.
1) What is the most likely diagnosis?
2) What is your next step?
3) What are the most common causes of primary and secondary adrenal insufficiency?
4) what is the treatment of adrenal insufficiency?
5) What is Stress dose of Steroids? dosage?
Sample Solution
Adrenal Insufficiency
Adrenal insufficiency occurs when the adrenal glands don’t make enough of the hormonal cortisol. Cortisol helps break down fats, proteins, and carbohydrates in your body. It also controls blood pressure and affects how your immune system works. Adrenal insufficiency can be primary or secondary. Primary adrenal insufficiency (known as Addison`s disease) occurs when the adrenal glands are damaged. They don’t make enough of the hormones cortisol and aldosterone. This condition is rare. It may occur at any age. Secondary adrenal insufficiency starts when the pituitary gland doesn’t make enough of the hormone ACTH. As a result the adrenal glands don’t make enough cortisol. Hormonal replacement therapy is a common form of treatment for adrenal insufficiency, which involves replacing the hormones that the adrenal glands no longer produce, including cortisol. To replace cortisol, doctors usually prescribe hydrocortisone as a pill several times per day.
